Latchy

10+ Year Member
Mar 5, 2009
32
0
Status
Pre-Medical
Do MD's in Internal Medicine still preform life saving procedures like placing Central Lines, Defibrillation etc... ?

What are the diffrences from an ER doctor to an Intenal Medicine doctor?

Latchy
 

Rendar5

15+ Year Member
Nov 12, 2003
7,007
634
Florida
Status
Attending Physician
well, I wouldn't call a central line life-saving usually lol. The short of it: Internal medicine deals with patients in the hospitals as a hospitalist, or can deal with patients in clinic on an outpatient basis like family medicine doctors. They don't specialize and no longer commonly work in emergency medicine, nor do they work in intensive care units, generally. In the hospital, their job is to refine or correct the admitting diagnosis, (if anything, they're pathophysiology specialists), adjust therapy to meet the patient's daily needs, establish an appropriate discharge plan including appropriate follow-up and appropriate outpatient therapy.

In terms of "shocking" someone or procedures, they may need to put in central lines, but they may not always be the ones to do so. When there is a code on the floor of the hospital, they may be part of the code team and run/direct the resuscitation, but they won't be as skilled at this as an emergency doctor. Mostly because they don't do it as often, and they may ntot even be part of a code team in the hospital. In teaching hospitals, it is the residents who do this with an attending overseeing. I dont' know what it's like in the community setting, but I have a feeling nurses are more the ones who do this.

Emergency Physicians deal with anything and everything that comes into the emergency room, specialize in acute and hyperacute medical and surgical issues, and are well-trained in the art of resuscitation. We do initial diagnosis and management, but in many cases, we are not the ultimate provider. Our job is to figure out what's going on and get them where they need to be in one piece, whether that is home with stitches, referal to an outpatient specialist, transfer to other hospitals, or admission to any of the hospital's inpatient services. We do life-saving procedures, but these are often a bridge to definitive care. If a guy comes in with major traumas, we're going to find out if there's internal bleeding, we'll insert breathing tubes, we'll save someone's life temporarily by shoving in a chest tube or draining fluid from around the heart if we need to. And then we'll get them to a trauma surgeon who will definitively fix what's going on.
 
OP
L

Latchy

10+ Year Member
Mar 5, 2009
32
0
Status
Pre-Medical
OK Thanks for your help.

So what type of doctors work in the ICU?
 

Rendar5

15+ Year Member
Nov 12, 2003
7,007
634
Florida
Status
Attending Physician
There is significant overlap and significantly different focuses for both docs. As quick examples of where we meet and separate:

Internists would be better trained to provide appropriate diabetes management both within the hospital and without.
Internists are better trained to manage someone's blood pressure to prevent complications.
Internists are better trained on treating someone with multiple medical allergies (to get around them or to treat through them)
Internists are better at managing asthma to prevent attacks or deal with ongoing attacks.

EP's are better trained for recognition and initial management of diabetic emergencies.
EP's are better trained for a hypertensive emergency when the pressure is high enough to actively affect someone's organs
EP's would be better trained to provide appropriate therapy for someone with anaphylactic shock from say a peanut allergy or a bee sting or taking the wrong medication.
EP's are better trained for managing someone coming in with an asthma attack, not responding to their at-home treatments, possibly needing intubation.
 

Rendar5

15+ Year Member
Nov 12, 2003
7,007
634
Florida
Status
Attending Physician
OK Thanks for your help.

So what type of doctors work in the ICU?
Intensivists work in the ICU. The field is generally a subspecialty of internal medicine. Emergency physicians can also train to work in ICU's. Residency in both fields typically involves a few months of ICU work.
 
OP
L

Latchy

10+ Year Member
Mar 5, 2009
32
0
Status
Pre-Medical
I get you now :)

If any of you watch [scrubs] what possition is J.D. Is he an Internist or an ER Doctor? Because more often then not you do see JD, eliot etc... deadling with codes when they are not even on the floor, there pager tells them that there is a code.

Latchy
 

Rendar5

15+ Year Member
Nov 12, 2003
7,007
634
Florida
Status
Attending Physician
I get you now :)

If any of you watch [scrubs] what possition is J.D. Is he an Internist or an ER Doctor? Because more often then not you do see JD, eliot etc... deadling with codes when they are not even on the floor, there pager tells them that there is a code.

Latchy
They're internists (residents first few seasons then attendings), not EM docs.
 
OP
L

Latchy

10+ Year Member
Mar 5, 2009
32
0
Status
Pre-Medical
OK, so what you see the characters on scubs do is basicly what real life internists do or is it total fiction?

Latchy
 

Rendar5

15+ Year Member
Nov 12, 2003
7,007
634
Florida
Status
Attending Physician
Scrubs, aside form the fantasy elements, is very realistic in terms of looking at healthcare and the medical culture. Although, never ever perform CPR like Dr. Cox did. Weakest chest compressions EVER. That said, they show you the interesting cases. I don't really recall them having to run codes on a regular basis (which honestly is not all that interesting either. It's just following set algorithms).
 

Rendar5

15+ Year Member
Nov 12, 2003
7,007
634
Florida
Status
Attending Physician
Although, now that I think about it, the one strange thing about Sacred Heart Hospital is that it doesn't appear to have an emergency department. The episode with the E. Coli outbreak on the news and all the people rushing to the hospital? the ED deals with that, you don't have IM residents triaging or admitting.
 
OP
L

Latchy

10+ Year Member
Mar 5, 2009
32
0
Status
Pre-Medical
Rendar5 Thannk you for all your help.

One last question, where about in the hospital do internists work?

Latchy
 

Rendar5

15+ Year Member
Nov 12, 2003
7,007
634
Florida
Status
Attending Physician
on any regular non-specialty hospital floor, or they have their own outside practice
 
OP
L

Latchy

10+ Year Member
Mar 5, 2009
32
0
Status
Pre-Medical
So that part of scrubs where all the Internists are in the ICU that is total fiction and also Season 1 Ep.1 where JD is on call and is constantly paged to deal with patients in the ER thats also fiction?
 

tkim

10 cc's cordrazine
15+ Year Member
Aug 2, 2002
7,638
364
New England
Status
Attending Physician
Rendar could use your help here :-(
Uh, dude, Rendar is a resident and pretty busy. While it's nice that he's on here answering questions, bumping your thread four hours after your last post is pretty demanding.

Let me sum it up for you:

"Scrubs" is a TV show. There are some elements of realism but it doesn't accurately reflect all aspects of medicine. If you want to get a more realistic view, you should shadow a doc in the hospital. Please don't get all of your medical info from TV shows.
 
OP
L

Latchy

10+ Year Member
Mar 5, 2009
32
0
Status
Pre-Medical
Uh, dude, Rendar is a resident and pretty busy. While it's nice that he's on here answering questions, bumping your thread four hours after your last post is pretty demanding.

Let me sum it up for you:

"Scrubs" is a TV show. There are some elements of realism but it doesn't accurately reflect all aspects of medicine. If you want to get a more realistic view, you should shadow a doc in the hospital. Please don't get all of your medical info from TV shows.
4 Hours? (Check Again)

I'm asking the questons to get real details, so that i'm not mislead by a TV show and never will be.
 

Hernandez

Paranoid and Crotchety...
15+ Year Member
May 14, 2004
21,169
6,932
knee deep in dog muck and crusty jugglers......
Status
Attending Physician
The correct answer is yes. To any and all. The scope of acuity that IM docs handles varies from doc to doc and hospital to hospital. Some EDs have the Im docs come down to eval the pt to make the decision if they are discharged, some hospitals have Internists running codes and the ICUs.

Some hospitals have all codes run by ED docs, have only Intensivists in the ICU and have restrictions on procedures that they can and can not do. so again, the answer is yes.